Çocuklarda, Ergenlerde ve Genç Yetişkinlerde Transtorasik Ekokardiyografi ve Floroskopi Kılavuzluğunda Cihazla Transkateter Atriyal Septal Defekt Kapatılması

Yıl 2022, Cilt: 16 Sayı: 6, 532 - 538, 30.11.2022

Ahmet Vedat Kavurt , Emine Gulsah Torun , Ayben Kilic , Denizhan Bağrul , Alper Gürsu , İbrahim Ece , İbrahim İlker Çetin

https://doi.org/10.12956/tchd.1143186

Öz

Amaç: Bu çalışmanın amacı, floroskopi ve transtorasik ekokardiyografi (TTE) eşliğinde transkateter atriyal septal defekt (ASD) kapatılmasının güvenlik ve etkinliğini değerlendirmek ve deneyimlerimizi sunmaktır.

Gereç ve Yöntemler: Bu çalışmada transkateter ASD kapatılması için kateter laboratuvarına alınan 108 hastanın dosyası geriye dönük olarak incelendi. On hastada septum/cihaz orantısızlığı (6) ve başta vena cava inferior rimi olmak üzere eksik rimler (4) nedeniyle işlemden vazgeçildi.

Bulgular: Toplam 98 hastaya (59 kadın) TTE rehberliğinde transkateter ASD kapatma uygulandı. Hastaların ortalama yaşı 9.5 ± 6 yıl (2.6-46) ve ortalama ağırlığı 30.3 ± 15.3 kg (12-80)’di. TTE kılavuzluğunda ASD kapatma 98 hastanın 92’sinde (%94) başarıyla uygulandı. TTE ile ölçülen en büyük ASD çapı ortanca değeri 10.75 mm (çeyrekler arası aralık (ÇAA) 9.12-14)’dü. Floroskopi ile ölçülen gerilmiş balon çapı ortanca değeri 14 mm (ÇAA 12.4-18)’di. Ortanca cihaz bel çapı 14 mm (ÇAA 13-18), ortanca cihaz sol atriyal (SlA) disk çapı 28 mm (ÇAA 26-31) ve SlA disk çapının toplam septal çapa oranı ortanca değeri %75 (ÇAA 68-81)’di. Ortanca floroskopi ve işlem süreleri sırasıyla 8 dakika (ÇAA 5.6-13.75) ve 36.5 dakika (ÇAA 30-49)’du.

Sonuç: TTE ve floroskopi kılavuzluğunda transkateter ASD kapatılması çocuklarda, ergenlerde ve genç erişkinlerde güvenli ve etkilidir.

Anahtar Kelimeler

Atriyal septal defekt, transtorasik ekokardiyografi, transkateter ASD kapatma.

Transthoracic Echocardiography and Fluoroscopy Guided Transcatheter Atrial Septal Defect Closure with Device in Children, Adolescents, and Young Adults

Öz

Objective: The aim of this study was to evaluate the safety and efficacy of transcatheter atrial septal defect (ASD) closure guided by fluoroscopy and transthoracic echocardiography (TTE) and to present our experiences.

Material and Methods: In this study, we evaluated 108 patients’ files taken to the catheter laboratory for transcatheter ASD closure retrospectively. The procedure was abandoned in ten patients because of septum device disproportion (6) and deficient rims (4), mainly inferior vena cava rim.

Results: Transcatheter ASD closure guided by TTE was performed in 98 patients (59 female). The mean age of patients was 9.5±6 years (2.6-46), and the mean weight was 30.3±15.3kg (12-80). TTE-guided ASD closure was successfully performed in 92 of 98 (94%) patients. The median largest ASD diameter measured by TTE was 10.75 mm (interquartile range (IQR) 9.12-14. The median stretched balloon diameter measured by fluoroscopy was 14 mm (IQR 12.4-18). The median device waist diameter was 14 mm (IQR 13-18), the median device left atrial (LA) disk diameter was 28 mm (IQR 26-31), and the median ratio of LA disc diameter to total septal diameter was 75% (IQR 68-81). The median fluoroscopy and procedural times were 8 minutes (IQR 5.6-13.75) and 36.5 minutes (IQR 30-49) respectively.

Conclusion: Transcatheter ASD closure guided by TTE and fluoroscopy is safe and effective in children, adolescents, and young adults.

Anahtar Kelimeler

Atrial septal defect, transthoracic echocardiography, transcatheter ASD closure

Kaynakça

• King TD, Mills NL. Nonoperative closure of atrial septal defects. Surgery 1974;75:383–8
• Park MK, Salamat M. Atrial septal defect. In: Park MK, Salamat M, eds. Park’s Pediatric Cardiology For Practitioners 7th ed. Philadelphia: Elsevier 2020:130-51.
• Du ZD, Hijazi ZM, Kleinman CS, Silverman NH, Larntz K. Amplatzer Investigators. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol 2002;39:1836-44.
• Rana BS. Echocardiography guidance of atrial septal defect closure. J Thorac Dis. 2018;10:2899-908.
• Yamano M, Yamano T, Nakamura, T, Zen K, Shiraishi H, Shirayama T et al. Appropriate selection of echocardiographic guidance for transcatheter atrial septal defect closure. Int J Cardiovasc Imaging 2020;36:855-63.
• El Doklah EH, El Shedoudy SA, El Saied AM, Kassem HK, El Masry MM. Assessment of Value of Three Dimensional Transesophageal Echocardiography versus Conventional Two Dimensional Transesophageal Echocardiography in Guiding Transcatheter Closure of Atrial Septal Defects and Patent Foramen Ovale. J Saudi Heart Assoc 2022;34:85-99.
• Herbold T, Chon SH, Grimminger P, Maus M, Schmidt H, Fuchs H, et al. Endoscopic Treatment of Transesophageal Echocardiography-Induced Esophageal Perforation. J Laparoendosc Adv Surg Tech A 2018;28:422-8.
• Puchalski MD, Lui GK, Miller-Hance WC, Brook MM, Young LT, Bhat A, et al. Guidelines for Performing a Comprehensive Transesophageal Echocardiographic: Examination in Children and All Patients with Congenital Heart Disease: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2019;32:173-215.
• Hauser ND, Swanevelder J. Transoesophageal echocardiography (TOE): contra-indications, complications and safety of perioperative TOE. Echo Res Pract 2018;5:101-13.
• Basman C, Parmar YJ, Kronzon I. Intracardiac Echocardiography for Structural Heart and Electrophysiological Interventions. Curr Cardiol Rep 2017;19:102.
• Baruteau AE, Hascoët S, Fraisse A. Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in children. J Thorac Dis 2017;9:1247-56.
• Erdem A, Sarıtas T, Zeybek C, Yucel IK, Erol N, Demır H, et al. Transthoracic echocardiographic guidance during transcatheter closure of atrial septal defects in children and adults. Int J Cardiovasc Imaging 2013;29:53-61.
• Silvestry FE, Cohen MS, Armsby LB, Burkule NJ, Fleishman CE, Hijazi ZM, et al. Guidelines for the Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen Ovale: From the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. J Am Soc Echocardiogr 2015;28:910-58.
• Chambault AL, Olsen K, Brown LJ, Mellor SL, Sorathia N, Thomas AE, et al. Transcatheter versus surgical closure of atrial septal defects: a systematic review and meta-analysis of clinical outcomes. Cardiol Young 2022;32:1-9. doi: 10.1017/S1047951121004583.
• Fritz C, Engelhardt A, Grohmann J, Dähnert I, Hummel J, Tanase D, et al. A multi-center trial on efficacy and safety of the LifeTech CeraFlexTM ASD occluder for transcatheter closure in patients with secundum atrial septal defects. Cardiovasc Diagn Ther. 2022;12:475-84.
• Everett AD, Jennings J, Sibinga E, Owada C, Lim DS, Cheatham J, et al. Community use of the amplatzer atrial septal defect occluder: results of the multicenter MAGIC atrial septal defect study. Pediatr Cardiol 2009;30:240-7.
• Bartakian S, El-Said HG, Printz B, Moore JW. Prospective randomized trial of transthoracic echocardiography versus transesophageal echocardiography for assessment and guidance of transcatheter closure of atrial septal defects in children using the Amplatzer septal occluder. JACC Cardiovasc Interv 2013;6:974-80.
• El-Said H, Hegde S, Foerster S, Hellenbrand W, Kreutzer J, Trucco SM, et al. Device therapy for atrial septal defects in a multicenter cohort: Acute outcomes and adverse events. Catheter Cardiovasc Interv 2015;85:227-33 .
• Moore JW, Vincent RN, Beekman RH 3rd, Benson L, Bergersen L, Holzer R, et al. NCDR IMPACT Steering Committee. Procedural results and safety of common interventional procedures in congenital heart disease: initial report from the national cardiovascular data registry. J Am Coll Cardiol 2014;64:2439-51.
• Ye Z, Li Z, Yi H, Zhu Y, Sun Y, Zhang H, et al. Optimization of Echo Views for Percutaneous Device Closure of Pediatric Atrial Septal Defect through the Femoral Vein Guided by Transthoracic Echocardiography without Radiation. J Interv Cardiol 2020;2020:8242790.
• Li GS, Li HD, Yang J, Yang J, Zhang WQ, Hou ZS, et al. Feasibility and safety of transthoracic echocardiography-guided transcatheter closure of atrial septal defects with deficient superior-anterior rims. PLoS One 2012;7:e51117.
• Sharfi MH, Al-Ata J, Al-Kouatli A, Baho H, Al-Ghamdi L, Galal MO. Safety and efficacy of transcatheter closure of atrial septal defect type II under transthoracic echocardiographic guidance: A case control study. J Saudi Heart Assoc 2019;31:2-8.
• Zhang WL, Liang F. An asymptomatic child of pre-perforation erosion after transcatheter closure of atrial septal defect. J Cardiothorac Surg 2021;16:263.
• Kibler M, Marzak H, Jesel L, Ohlmann P. High-grade atrioventricular block occurring during percutaneous closure of patent foramen ovale: a case report. Eur Heart J Case Rep 2020;4:1-5. doi: 10.1093/ehjcr/ytaa141.
• Wintzer-Wehekind J, Horlick E, Ibrahim R, Cheema, AN, Labinaz M, Nadeem N, et al. Effect of Clopidogrel and Aspirin vs Aspirin Alone on Migraine Headaches After Transcatheter Atrial Septal Defect Closure: One-Year Results of the CANOA Randomized Clinical Trial. JAMA Cardiol 2021;6:209-13.
• Leger CS, DeSouza JF. Migraine Modulation and Debut after Percutaneous Atrial Septal Defect Closure: A Review. Front Neurol 2017;8:68.
• Wertman B, Azarbal B, Riedl M, Tobis J. Adverse events associated with nickel allergy in patients undergoing percutaneous atrial septal defect or patent foramen ovale closure. J Am Coll Cardiol 2006;47:1226-7.
• Kim HJ, Shin JU, Lee J, Lee H, Jin S, Kim SH, et al. Positive reactions to nickel on a patch test do not predict clinical outcome of nickel alloy-based atrial septal defect occluder implantation. Dermatology 2015;230:184-8.
• Şebnem Özbay Y, Eker R, Dindar A, Aydoğan Ü, Nişli K. Transcatheter closure of atrial septal defect in children: Single-center experience, mid-term follow-up results. Turk Arch Pediatr 2022;57:406-12.
• Ackermann S, Quandt D, Hagenbuch N, Niesse O, Christmann M, Knirsch W, et al. Transcatheter Atrial Septal Defect Closure in Children with and without Fluoroscopy: A Comparison. J Interv Cardiol 2019;2019:6598637.
• Yang Y, Zhang W, Wu Q, Gao L, Jin W, Zhao T. Transcatheter closure of atrial septal defects without fluoroscopy: a well-established procedure for alternative use in children. EuroIntervention 2016;12:652-57.
• Xu WZ, Shou XY, Li JH, Yu JG, Zhang ZW, Yu J, et al. Non-fluoroscopic percutaneous transcatheter closure of atrial septal defects in children under transesophageal echocardiographic guidance. World J Pediatr 2018;14:378-82.
• Huang LL, Wu J, Chen M, Jiang CL, Zeng C, Su CX, et al. Transcatheter closure of atrial septal defect with deficient posterior-inferior or inferior vena cava rim under echocardiography only: a feasibility and safety analysis. Cardiol Young 2022;32:589-96.
• Arı S, Arı H, Can V, Çamcı S, Melek M. Streamlined percutaneous atrial septal defect closure in adults. Eur Res J 2020;6:485-91